Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.Methods:Between January 2007 and December 2009,409 immediate breast reconstructions(IBRs)were performed in patients with Stage II-III breast cancer.Data were collected on preoperative,operative,and postoperative factors.Results:There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM(P<0.0001).Seventy-five percent of all patients with stage II disease and 50%of patients with stage III disease underwent SSM;similarly,75.5%of patients with stage II and 49.1%of patients with stage III disease who received NAC underwent SSM with immediate reconstruction,in spite of having a greater proportion of stage III patients(P<0.01).In addition,patients who received NAC followed by SSM with IBR had larger tumors(mean,3.5 cm vs.3.1 cm,P<0.001).The type of IBR,and size of skin defect was significantly affected by whether the patient underwent SSM or non-SSM(P=0.001,P<0.01,respectively).Conclusion:We are increasingly considering NAC to be an important tool to potentially reduce the morbidity of mastectomy,including the need to resect breast skin,which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer.Specifically,our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases,thus improving reconstructive outcomes and patient well-being.

Lessons Learned from Three Different Acellular Dermal Matrices in Direct-to-Implant Breast Reconstruction

The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex®, Strattice® and Braxon®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice® acellular dermal matrix (SADM), 22 cases Epiflex® acellular dermal matrix (EADM) and the remaining 35 cases Braxon® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon® matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon® ADM showed a significantly lower time of hospitalization (p < 0.001). Conclusion: No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon® ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.